The long-term objective of this Mentored Patient-Oriented Research Career Development Award is to develop the Principle Investigator's skills and knowledge in observational study design, scale development and validation and outcome studies focused on psychoactive drug use and its impact on outcomes in critically ill patients. The thrust of this research project is three-fold: 1) To determine the association of psychoactive (sedative-hypnotic, narcotic and anticholinergic) drugs with persistent delirium post-ICU discharge. Persistent delirium is defined as delirium, which is present in the ICU and is also present post-ICU discharge. We will examine the drugs individually and in combinations, examine the influence of drug class and examine the influence of cumulative dose of drug received. 2) To identify leading drugs or combinations (called HIGH RISK DRUGS) associated with the highest risk of persistent delirium. 3) Controlling for other delirium risk factors (e.g., dementia, illness severity, invasive procedures, medical comorbidities, invasive procedures, and metabolic abnormalities) we will determine the independent contribution of the HIGH RISK DRUGS to persistent delirium. The applicant will achieve the long-term objectives by completing the well-integrated specific aims under the supervision of a highly qualified mentor and guidance by an Advisory Committee with multidisciplinary ICU clinical research expertise, experience in delirium research, and assistance by expert consultants in clinical epidemiology and biostatistics. The applicant has a focused program of didactic courses, participation in research seminars and training in pharmacology that will complement her previous MPH curriculum. The research projects have been selected, in part because they will provide an excellent training vehicle for furthering the applicant's transition to an independent investigator in ICU patient-oriented research. Ultimately, we hope this work will lead to the development of specific interventions in ICU drug therapy vital to the care of more than four million critically ill patients in the United States.